Innovation and Commitment Needed to Turn Back the HIV Epidemic Among Girls

Editor’s Note: In observance of International Day of the Girl, the Centers for Disease Control and Prevention provided this information. You can learn more about CDC efforts to fight HIV among young women and girls around the world here.

Dr. Shannon Hader, Director, Division of Global HIV & TB, CDC

Every year, an astonishing 380,000 adolescent girls and young women [PDF 2,597 KB] are infected with HIV. That’s more than 1,000 every day. These numbers are worth noting any day, but it’s especially relevant today as we recognize International Day of the Girl.

Consider sub-Saharan Africa, where one in four new HIV infections [PDF 2,597 KB] occurs among young women and girls. In the hardest hit countries, girls account for more than 80 percent of all new HIV infections among adolescents. AIDS is the leading cause of death for girls aged 15-19 in eastern and southern Africa.

Many countries with the highest HIV prevalence are also experiencing a massive increase in their youth population. This so-called “youth bulge” of people under 30 increases the absolute number of young people at risk for HIV. So much so that, even if we continue to reduce HIV incidence at the pace we are currently doing, the absolute number of young people susceptible to and possibly infected by HIV is estimated to increase dramatically in the next five years. Given these demographic trends, we have to work hard just to keep up with the epidemic, and even harder to get ahead of it.

If we are to turn the tide on HIV globally, we must act now to confront the HIV crisis among young women and girls. And, although we have a number of tools, the reality is that it won’t be easy. There is no magic bullet – no easy answer.

Here at CDC’s Division of Global HIV & TB, we know that the root causes that give rise to this disproportionate burden of HIV among young women and girls are complex – poverty, access to education, violence and other gender inequities. Our approach must be equally layered. It will also require us to be creative, vigilant and tireless.

At CDC’s Division of Global HIV & TB, we are working to make an impact in the fight against HIV among young women and girls.

Creating a supporting, empowering environment

Because every girl is part of a larger community, we are reaching out to families and communities to build skills and support that protect against HIV. In CDC’s Families Matter! [PDF 337 KB] program, for example, we work with 9-12 year old girls and their families in Kenya, Tanzania, Cote d’Ivoire, South Africa, Zambia, Mozambique, and Zimbabwe to give them knowledge, skills, comfort and confidence to have open parent-child discussions. The program has reached more than 450,000 families in 10 years.

Similarly, our Project AIM [PDF 457 KB] program in Botswana and South Africa pairs adult female mentors with young at-risk girls. Using role play and small group activities, these partnerships help girls focus on their future goals, which, in turn, helps them make better decisions about their health.

Addressing gender-based violence

According to data released in CDC’s June 2015 Morbidity and Mortality Weekly Report (MMWR), one in four girls in seven countries studied experience some form of childhood sexual violence by age 18. Experiencing violence is associated with negative outcomes including increased risk for sexual exploitation, unwanted pregnancy, and HIV.

As part of a global public-private partnership called Together for Girls and under the leadership of country governments, we are taking aim at the dual epidemics of violence and HIV, by implementing the Violence Against Children Surveys in 14 countries with high HIV burden – to get a clear picture of the severity of the problem and to inform targeted solutions. And through the THRIVES technical package we provide countries with tools such as parental training and household economic strengthening to help prevent violence against children.

Expanding access to treatment for HIV-positive girls and young women

Reaching girls and young women living with HIV with life-saving care and treatment is another critical piece of the puzzle. Across the globe, CDC is working hard to scale up access to ART for young HIV-positive women. Adolescents and young adults worldwide experience challenges remaining in and fully benefiting from care. By tailoring materials and interventions to the unique needs of young women, we aim to improve their engagement in care and adherence to treatment.

We’re also spearheading peer-to-peer teen clubs in places like Malawi and Zimbabwe that help provide HIV-positive girls with the emotional and psychological support they need in addition to medical treatment.

Helping men control HIV can also help young women

Adult men can be among the hardest to reach and retain in HIV services. Among those on HIV treatment in sub-Saharan Africa, only 36 percent are men [PDF 339 KB] — if HIV-positive men aren’t able to learn their status, access care and suppress their viral load, they lose out on treatment benefits. Benefits that also include significantly reducing transmission of HIV to partners who may include young women.

We are redoubling our efforts to ensure HIV-positive men know their status, are linked to treatment, and virologically suppressed. The new WHO ‘test and start’ guidelines, that support HIV treatment at all CD4 counts, may reduce missed opportunities to engage men by providing a tangible, accessible benefit – treatment — to accessing care as soon as possible.

For young men who are HIV-negative, we encourage voluntary male medical circumcision – a proven prevention intervention — to help them stay HIV-free. As of September 2014, as an implementing partner of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), CDC supported 3.2 million (or approximately half) of a total of 6.5 million circumcisions in 14 sub-Saharan African countries.

Partnering through PEPFAR to reach young women and girls

Through PEPFAR, CDC is also implementing two powerful HIV initiatives aimed at reaching children, adolescents, and young women.

Through the Accelerating Children’s HIV/AIDS Treatment initiative we support PEPFAR’s goal to enable 300,000 more children to receive life-saving ART across priority countries in sub-Saharan Africa. Through the DREAMS initiative, a multi-pronged approach to help adolescent girls and young women live Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe lives, PEPFAR and its implementing agencies aim to drive down HIV infections among girls ages 15-24 in high-burden geographic areas.

These critical programs will make a difference.

But the data – and the young women we encounter around the world – tell us clearly that we must do more. As we mark the International Day of the Girl, we must recommit ourselves to reversing the HIV epidemic among girls, so they can grow up to lead a generation free of AIDS.

A fuller version of this blog was originally posted on CDC’s ‘Our Global Voices’blog.

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